{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:29Z","timestamp":1787027669303,"version":"build-2736575974"},"reference-count":52,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,8]],"date-time":"2023-07-08T00:00:00Z","timestamp":1688774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Ehlers\u2013Danlos syndromes are a heterogeneous group of Heritable Connective Tissue Disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Among the different types, the hypermobile Ehlers\u2013Danlos syndrome is the most frequent and includes generalized joint hypermobility as the major diagnostic criterion. Joint hypermobility in hypermobile Ehlers\u2013Danlos syndrome is often associated with pain that does not always allow the use of effective pain-reducing treatments. Patients with hEDS constantly describe their pain in detail. Eighty-nine patients with hEDS diagnoses were recruited and evaluated. They were asked to describe their pain in writing. The texts were examined through Linguistic Inquiry and Word Count. Correlational analyses were conducted between pain perception and language. A comparison of high\/low pain perception and the quality of metaphors was carried out. The results showed that language quality varies depending on how much pain is perceived. The greater the pain is perceived, the lesser the positive effects and the greater the negative effects and dehumanizing metaphors are being used. Moreover, a greater pain seems to be related to a verbal experience of greater isolation and less self-care. In conclusion, the use of metaphors is a useful tool for examining illness experience and may help clinicians in the rehabilitation program.<\/jats:p>","DOI":"10.3390\/brainsci13071042","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:35:21Z","timestamp":1688949321000},"page":"1042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Language of Pain in the Hypermobile Ehlers\u2013Danlos Syndrome: Metaphors as a Key to Understanding the Experience of Pain and as a Rehabilitation Tool"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0268-4026","authenticated-orcid":false,"given":"Filippo","family":"Camerota","sequence":"first","affiliation":[{"name":"Physical Medicine and Rehabilitation, Umberto I University Hospital, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5952-3525","authenticated-orcid":false,"given":"Rachele","family":"Mariani","sequence":"additional","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies Sapienza, University of Rome, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Cordiano","sequence":"additional","affiliation":[{"name":"Fondazione Don Carlo Gnocchi, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Di Trani","sequence":"additional","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies Sapienza, University of Rome, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Lodato","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics, Department of Experimental Medicine, San Camillo Forlanini Hospital, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Ferraris","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics, Department of Experimental Medicine, San Camillo Forlanini Hospital, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3959-8137","authenticated-orcid":false,"given":"Massimo","family":"Pasquini","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7154-5882","authenticated-orcid":false,"given":"Claudia","family":"Celletti","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Umberto I University Hospital, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/s41572-020-0194-9","article-title":"The Ehlers-Danlos syndromes","volume":"6","author":"Malfait","year":"2020","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/ajmg.c.31552","article-title":"The 2017 international classification of the Ehlers-Danlos syndromes","volume":"175","author":"Malfait","year":"2017","journal-title":"Am. J. Med. Genet. Part C Semin. Med. Genet."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Di Giosaffatte, N., Ferraris, A., Gaudioso, F., Lodato, V., Savino, E., Celletti, C., Camerota, F., Bargiacchi, S., Laino, L., and Majore, S. (2022). Congenital Defects in a Patient Carrying a Novel Homozygous AEBP1 Variant: Further Expansion of the Phenotypic Spectrum of Ehlers-Danlos Syndrome Classical-like Type 2?. Genes, 14.","DOI":"10.3390\/genes13122358"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1102101","DOI":"10.3389\/fgene.2023.1102101","article-title":"Case report: Further delineation of AEBP1-related Ehlers\u2013Danlos Syndrome (classical-like EDS type 2) in an additional patient and comprehensive clinical and molecular review of the literature","volume":"14","author":"Yamaguchi","year":"2023","journal-title":"Front. Genet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/ajmg.c.31539","article-title":"A framework for the classification of joint hypermobility and related conditions","volume":"175","author":"Castori","year":"2017","journal-title":"Am. J. Med. Genet. Part C Semin. Med. Genet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/ana.21934","article-title":"Quality of life in the classic and hypermobility types of Ehlers-Danlos syndrome [corrected]","volume":"67","author":"Castori","year":"2010","journal-title":"Ann. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2989","DOI":"10.1002\/ajmg.a.36315","article-title":"Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrome\/Ehlers- Danlos syndrome, hypermobility type","volume":"161","author":"Castori","year":"2013","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1002\/ajmg.a.35483","article-title":"Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome, hypermobility type): Principles and proposal for a multidisciplinary approach","volume":"158","author":"Castori","year":"2012","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_9","first-page":"e325","article-title":"The multifaceted and complex hypermobility syndrome (a.k.a. Ehlers-Danlos Syndrome Hypermobility Type): Evaluation and management through a rehabilitative approach","volume":"164","author":"Celletti","year":"2013","journal-title":"Clin. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s10067-014-2499-0","article-title":"Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: Evidence for generalized hyperalgesia","volume":"34","author":"Rombaut","year":"2015","journal-title":"Clin. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/ajmg.c.31950","article-title":"Pain in the Ehlers-Danlos syndromes: Mechanisms, models, and challenges","volume":"187","author":"Malfait","year":"2021","journal-title":"Am. J. Med. Genet. Part C Semin. Med. Genet."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"580460","DOI":"10.1155\/2013\/580460","article-title":"Evaluation of kinesiophobia and its correlations with pain and fatigue in joint hypermobility syndrome\/Ehlers-Danlos syndrome hypermobility type","volume":"2013","author":"Celletti","year":"2013","journal-title":"BioMed Res. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1016\/j.jpainsymman.2010.09.012","article-title":"Neuropathic pain is a common feature in Ehlers-Danlos syndrome","volume":"41","author":"Camerota","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1002\/ejp.856","article-title":"Central sensitization as the mechanism underlying pain in joint hypermobility syndrome\/Ehlers-Danlos syndrome, hypermobility type","volume":"20","author":"Celletti","year":"2016","journal-title":"Eur. J. Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1093\/pm\/pnaa038","article-title":"Pain due to Ehlers-Danlos Syndrome Is Associated with Deficit of the Endogenous Pain Inhibitory Control","volume":"21","author":"Leone","year":"2020","journal-title":"Pain Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1093\/pm\/pnaa467","article-title":"The Language of Pain: Is There a Relationship Between Metaphor Use and Adjustment to Chronic Pain?","volume":"23","author":"Munday","year":"2022","journal-title":"Pain Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1016\/S0277-9536(99)00240-3","article-title":"Complaining about chronic pain","volume":"49","author":"Kugelmann","year":"1999","journal-title":"Soc. Sci. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Lascaratou, C. (2007). The Language of Pain, John Benjamins.","DOI":"10.1075\/celcr.9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/emre.12176","article-title":"Qualitative data analysis: Exploring themes, metaphors and stories","volume":"16","author":"Cassell","year":"2019","journal-title":"Eur. Manag. Rev."},{"key":"ref_20","first-page":"166","article-title":"Linguistic predictors of adaptive bereavement","volume":"72","author":"Pennebake","year":"1997","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_21","unstructured":"Solano, L. (2013). Tra Mente e Corpo [Between Mind and Body], Raffaello Cortina Editore."},{"key":"ref_22","first-page":"95","article-title":"Elaborare le esperienze difficili scrivendo. La tecnica della scrittura di James Pennebaker [Processing difficult experience trough writing. Pennebacker\u2019s writing technique]","volume":"24","author":"Renzi","year":"2014","journal-title":"Nuove Arti Ter."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/papt.12158","article-title":"Alexithymia according to Bucci\u2019s multiple code theory: A preliminary investigation with healthy and hypertensive individuals","volume":"91","author":"Mariani","year":"2018","journal-title":"Psychol. Psychother. Theory Res. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1080\/08870446.2019.1667500","article-title":"The effects of an expressive writing intervention on pregnancy rates, alexithymia and psychophysical health during an assisted reproductive treatment","volume":"35","author":"Renzi","year":"2019","journal-title":"Psychol. Health"},{"key":"ref_25","first-page":"452","article-title":"Giving words to emotions: The use of linguistic analysis to explore the role of alexithymia in an expressive writing intervention","volume":"23","author":"Renzi","year":"2020","journal-title":"Res. Psychother. Psychopathol. Process Outcome"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1207\/s15327868ms0204_2","article-title":"Metaphorical Uses of Language in the Expression of Emotions","volume":"2","author":"Fainsilber","year":"1987","journal-title":"Metaphor Symb. Act."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.11124\/JBISRIR-2017-003773","article-title":"Mental health and wellbeing during the transition to fatherhood: A systematic review of first-time fathers\u2019 experiences","volume":"16","author":"Baldwin","year":"2018","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1080\/08893675.2021.1951902","article-title":"More than you were: Writing my father\u2019s life, death and addiction","volume":"34","author":"Thatcher","year":"2021","journal-title":"J. Poet. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Friedman, H.S., and Silver, R.C. (2007). Foundations to Health Psychology, Oxford University Press.","DOI":"10.1093\/oso\/9780195139594.001.0001"},{"key":"ref_30","unstructured":"Pennebaker, J.W., Booth, R.J., and Francis, M.E. (2007). Operator\u2019s Manual: Linguistic Inquiry and Word Count: LIWC2007, LIWC.net."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1146\/annurev.psych.54.101601.145041","article-title":"Psychological aspects of natural language use: Our words, ourselves","volume":"54","author":"Pennebaker","year":"2003","journal-title":"Annu. Rev. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/0261927X09351676","article-title":"The psychological meaning of words: Liwc and computerized text analysis methods","volume":"29","author":"Tausczik","year":"2010","journal-title":"J. Lang. Soc. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1080\/15298868.2017.1368696","article-title":"Metaphors can give life meaning","volume":"17","author":"Baldwin","year":"2018","journal-title":"Self Identity"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1521\/soco.2019.37.3.314","article-title":"Beneath the surface: Abstract construal mindset increases receptivity to metaphors in health communications","volume":"37","author":"Landau","year":"2019","journal-title":"Soc. Cogn."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0304-3959(75)90044-5","article-title":"The McGill Pain Questionnaire: Major properties and scoring methods","volume":"1","author":"Melzack","year":"1975","journal-title":"Pain"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/archpsyc.1965.01720310065008","article-title":"A Self-Rating Depression Scale","volume":"12","author":"Zung","year":"1965","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Dunstan, D.A., Scott, N., and Todd, A.K. (2017). Screening for anxiety and depression: Reassessing the utility of the Zung scales. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1489-6"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0033-3182(71)71479-0","article-title":"A rating instrument for anxiety disorders","volume":"12","author":"Zung","year":"1965","journal-title":"Psychosomatics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S1297-319X(01)00341-4","article-title":"Fibromyalgia in Italian patients with primary Sj\u00f6gren\u2019s syndrome","volume":"69","author":"Ostuni","year":"2002","journal-title":"Jt. Bone Spine"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mariani, R., Musetti, A., Di Monte, C., Danskin, K., Franceschini, C., and Christian, C. (2021). Maladaptive Daydreaming in Relation to Linguistic Features and Attachment Style. Int. J. Environ. Res. Public Health, 30.","DOI":"10.3390\/ijerph19010386"},{"key":"ref_41","unstructured":"Cornell, W.F. (2021). Emotional Communication and Therapeutic Change: Understanding Psychotherapy through Multiple Code Theory, Routledge\/Taylor & Francis Group."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/10926488.2010.510926","article-title":"Descriptions of pain, metaphor, and embodied simulation","volume":"25","author":"Semino","year":"2010","journal-title":"Metaphor Symb."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.tics.2004.07.002","article-title":"A unifying view of the basis of social cognition","volume":"8","author":"Gallese","year":"2004","journal-title":"Trends Cogn. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1177\/1363459318817943","article-title":"\u201cI feel like I\u2019m being stabbed by a thousand tiny men\u201d: The challenges of communicating endometriosis pain","volume":"24","author":"Bullo","year":"2010","journal-title":"Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"745081","DOI":"10.3389\/fpsyg.2021.745081","article-title":"Narratives of Dreams and Waking Thoughts: Emotional Processing in Relation to the COVID-19 Pandemic","volume":"12","author":"Mariani","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_46","unstructured":"Wegner, P. (2022). Psychosomatics Today, Routledge. Book Chapter Taylor & Francis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/bjhp.12432","article-title":"\u2018Barbed wire wrapped around my feet\u2019: Metaphor use in chronic pain","volume":"25","author":"Munday","year":"2020","journal-title":"Br. J. Health Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/j.1471-6712.2006.00399.x","article-title":"Living with a body separate from the self. The experience of the body in chronic benign low back pain: An interpretative phenomenological analysis","volume":"20","author":"Osborn","year":"2006","journal-title":"Scand. J. Caring Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/AJP.0b013e3182465cf7","article-title":"A randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with 48 chronic pain","volume":"29","author":"Gallagher","year":"2013","journal-title":"Clin. J. Pain"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2021\/6664864","article-title":"Pain Management through Neurocognitive Therapeutic Exercises in Hypermobile Ehlers-Danlos Syndrome Patients with Chronic Low Back Pain","volume":"2021","author":"Celletti","year":"2021","journal-title":"BioMed Res. Int."},{"key":"ref_51","unstructured":"Perfetti, C. (2016). Il Dolore Come Problema Riabilitativo, Piccin."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1016\/j.ridd.2012.06.018","article-title":"Relationship between fatigue and gait abnormality in joint hypermobility syndrome\/Ehlers-Danlos syndrome hypermobility type","volume":"33","author":"Celletti","year":"2012","journal-title":"Res. Dev. Disabil."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/7\/1042\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:09:11Z","timestamp":1760126951000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/7\/1042"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,8]]},"references-count":52,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["brainsci13071042"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13071042","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,8]]}}}